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Piriformis Syndrome
Treatment in Overland Park, KS · Dr. Ladd Carlston
What it feels like
Deep pain in the buttock. Pain shooting down the back of the leg. Numbness or tingling in the leg. Pain worse when sitting or with certain hip movements. Weakness in the affected leg.
What’s actually causing it
The piriformis is a deep hip rotator that sits right on top of — or in some people, wraps around — the sciatic nerve. When it gets tight and irritated, it squeezes the nerve and you get pain shooting down your leg. So everyone stretches it. And it helps — for about an hour. Then it tightens right back up. Here's what most people miss: the piriformis is tight because it's doing a job that isn't supposed to be its job. The piriformis is an external rotator of the hip. You know what else is an external rotator? The psoas. When the psoas is chronically tight — and it almost always is in people who sit a lot — it becomes weak. A tight muscle is a weak muscle. So the piriformis has to pick up the slack. It takes over the stabilization work that the psoas should be sharing, and it overworks until it locks down and compresses the nerve. Stretching the piriformis without addressing the tight psoas is like mopping the floor with the faucet still running.
How I treat it
I test the muscles around the affected area individually, find which ones aren’t firing, and reset the connection using gentle techniques. No cracking, no popping.
How long it takes
Most patients feel a difference after one session. Chronic cases typically resolve in 4–6 sessions.
Piriformis Syndrome vs. Sciatica
These get confused constantly. Sciatica is nerve pain caused by compression in the lower back — usually a disc issue. Piriformis syndrome is nerve pain caused by compression in the hip — a muscle issue. The symptoms overlap (both cause pain shooting down the leg), but the treatment is completely different. If someone is treating your piriformis syndrome like sciatica and adjusting your lumbar spine, they're working on the wrong end of the problem.
The Psoas Connection
This is the thing nobody checks. The psoas and the piriformis are both external rotators of the hip. They share stabilization duties. When the psoas gets locked short from chronic sitting, it can't do its share of the work. The piriformis compensates — it works harder, it tightens up, and eventually it compresses the sciatic nerve. I see this pattern constantly. Release the psoas, and the piriformis calms down on its own because it no longer has to overwork. Skip the psoas, and you'll be stretching your piriformis forever.
What I Do
First, I test both muscles — the piriformis and the psoas — to confirm the pattern. Then it's deep myofascial release of the psoas and iliacus first. This is the same work I do for lower back pain patients. Once the hip flexors release and can do their job again, I work directly on the piriformis to release the acute tightness and take pressure off the nerve. I also check the glutes — if they're inhibited (and they usually are when the hip flexors are tight), those need to come back online too. The whole hip complex has to work together, or the piriformis just gets overloaded again.
Timeline
Piriformis syndrome responds well once you address the right muscles. Most patients feel significant relief within 2–3 visits as the psoas releases and the piriformis stops overworking. Full resolution — where the pattern doesn't come back — takes 4–6 visits. I'll also give you specific movements to keep the psoas from locking back down, which is the real long-term prevention.
“I had been suffering for years and was unsuccessfully treated by others. In one visit, Dr. Ladd was able to find and address the real issue.”
Patient review · Piriformis Syndrome patient
Techniques I use for piriformis syndrome
Common questions
Is this the same as sciatica?
Not exactly. Sciatica comes from nerve compression in the lower back. Piriformis syndrome is the nerve getting squeezed in the hip. Both cause similar leg pain, but treatment is different.
How long does piriformis syndrome take to heal?
Usually 4–6 weeks with proper treatment. Pain improves quickly once the glutes are reactivated because the piriformis can finally relax.
Can I keep exercising?
Yes, but avoid high-impact leg exercises for the first 1–2 weeks. Once pain settles, we'll add glute activation exercises that actually fix the problem.
Will it come back?
Not if your glutes stay strong. Once we've reactivated them, maintenance care every 4–8 weeks keeps the pattern from returning.
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